Senior Process Executive – Pre-Authorization

Cognizant; Kuala Lumpur; On-site; MYR 100,000 - 150,000; Full time

Job summary

A leading technology company in Kuala Lumpur is seeking a Case Management Advisor for the Pre-Authorization process. Candidates should have 0-5 years of experience in medical claims processing and preferably a healthcare background. Proficiency in Cantonese, Mandarin, and English is essential for effective communication in this critical role.

Qualifications

• 0-5 years of experience in Pre-authorization or medical claims processing.
• Healthcare background preferred.
• Knowledge of billing codes (ICD 9, ICD 10, CPT) and insurance policies preferred.

Responsibilities

• Review and assess pre-authorization requests for completeness and eligibility.
• Verify medical charges against appropriate diagnosis and codes.
• Communicate results to members or providers.

Skills

Medical claims processing

Knowledge of medical terminology

Time management

Cantonese

Mandarin

English

Job description

Overview

Title: Advisor – Pre-Authorization

Location: Kuala Lumpur, Malaysia

Experience: 0-5 Years

Summary of the Role

The Case Management Advisor is responsible for Pre-Authorization process from members & medical providers to ensure that medical treatments, procedures, or medications requiring prior approval are authorized. This role is critical in streamlining the healthcare process, ensuring timely patient care, and facilitating proper reimbursement while adhering to insurance policies and regulatory guidelines.

Responsibilities

• Review and assess pre-authorization (PA) requests from members or providers for completeness, accuracy, and eligibility in accordance with policy terms and conditions.
• Verify medical charges against appropriate diagnosis, procedure, and medical codes to ensure consistency and compliance.
• Communicate Pre-authorization results to members or providers within the service level agreements
• Request additional information or clarification from members or providers to support PA decisions
• Escalating complex or exceptional cases to senior advisors or supervisors as needed

Qualifications

• With 0-5 years of experience in Pre-authorization or medical claims processing
• With Healthcare background is preferred
• With knowledge of medical terminology, billing codes (ICD 9, ICD 10, CPT) and medical insurance polices is preferred
• Good time management skill and ability to multitask
• Proficient in Cantonese, Mandarin, and English (speak, read, and write).

About Cognizant

Cognizant (Nasdaq: CTSH) engineers modern businesses. We help our clients modernize technology, reimagine processes and transform experiences so they can stay ahead in our fast-changing world. Together, we're improving everyday life. See how at www.cognizant.com or @cognizant.

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